Behavioral Health Provider Quality Manager - Northern California at Elevance Health

California, Pennsylvania, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Behavioral HealthIndustries

Requirements

Possess licensure for the state of California
Reside in or near Shasta or Humboldt counties (ideal)
Ability to work virtually and travel in the field as needed in Northern California
Schedule availability in Pacific Standard Time

Responsibilities

Establish relationships and engage with Behavioral Health (BH) providers to ensure measurable improvements in clinical and quality outcomes for members
Build relationships with internal clinical and quality departments to ensure high-quality care and achievement of HEDIS performance
Implement strategies that meet clinical, quality, and network improvement goals
Build positive working relationships with providers, state agencies, advocacy groups, and other market stakeholders
Meet routinely with strategic providers face-to-face, telephonically, and via Web-Ex to support training on Carelon processes, contracting/credentialing, and issue resolution
Act as a liaison between strategic providers and Carelon clinical, quality, provider strategy, operations, and claims teams for collaboration and coordination
Support regional and corporate initiatives regarding Carelon Select Provider (CSP) program, clinical innovation, and thought leadership
Create and maintain linkages between providers across all levels of care, community-based services, and resources to improve transitions of care and continuity of services
Partner with network providers and Carelon stakeholders to operationalize innovative programs and online resources for improved clinical and quality outcomes
Analyze provider reports on cost, utilization, and outcomes, present data to providers, and highlight trends
Identify data outliers and opportunities for improvement for individual providers
Identify high-performing and innovative providers for new programmatic incentives or payment models
Participate in identifying opportunities for expansion and development of innovative pilot programs, including implementation, launch, and measurement of efficacy and outcomes
Contribute to identifying high-quality program ideas/designs for the local market
Provide consultation to providers for clinically complex members as applicable
Surface clinical and quality issues to regional teams and participate in addressing concerns
Conduct quarterly physician record reviews or as needed with network providers across all service levels
Assist with provider orientations and provider training events

Skills

Behavioral Health

Provider Engagement

Quality Improvement

HEDIS

Clinical Outcomes

Performance Improvement

Stakeholder Management

Data Analysis

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters

1944Year Founded

$309.4MTotal Funding

IPOCompany Stage

Enterprise Software, Social Impact, HealthcareIndustries

10,001+Employees

Benefits

Medical, dental, & vision insurance

401(k) + match

Paid holidays

Paid Time Off

Incentive bonus programs

Stock purchase plan

Life insurance

Wellness Programs

Financial education resources

Adoption & Surrogacy Assistance

Dependent-care Flexible Spending Account (DCFSA)

Parental Leave

Parental Transition Week

Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.

Lawsuit against CMS over MA Star Ratings could lead to financial penalties.

CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.

Acquisition of CareBridge enhances home health services within Carelon division.

Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.

Predictive analytics support early disease detection, aligning with Elevance's whole health approach.

Telehealth expansion offers opportunities to reach more patients remotely.

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